Naloxone Administration Evaluation Received Naloxone - ohrdp 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and birthdate in the designated fields at the top of the form.
3. Fill in the date of the overdose occurrence. This is crucial for tracking and evaluation purposes.
4. Indicate who administered the naloxone by checking the appropriate box. If they were trained, please specify.
5. Select where the overdose occurred from the options provided, or write in another location if necessary.
6. Detail what drugs were involved in the overdose, or select 'don't know' if applicable.
7. Describe what happened after receiving naloxone by selecting one of the options provided.
8. Indicate how long it took for naloxone to work and how many doses you received.
9. Answer whether someone called 911 and provide additional details if applicable regarding EMS involvement.
10. Finally, reflect on whether you would want to receive naloxone again and provide any comments or evaluations as needed.

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